The management of urological complications in surgery for the treatment of severe endometriosis

The management of urological complications in surgery for the treatment of severe endometriosis

Giuseppe Caleffi

DSS in Urological Surgery Minimally invasive laparoscopy Operative Unit of Urology – IRCCS “Sacro Cuore-Don Calabria” – Negrar (VR); ISSA teacher (International School of Surgical Anatomy)

giuseppe.caleffi@sacrocuore.it


DOI: 10.53146/lriog1202137

Abstract

The iatrogenic damage to the urinary tract during gynecological surgery for the eradication of pelvic endometriosis can have significant morbidity. Although most cases of ureteral injury can occur even in the absence of significant risk factors, the incidence of urinary tract injury increases especially in patients with visceral adhesions secondary to previous pelvic surgery or inflammatory bowel disease, infections and patients with deeply infiltrating pelvic endometriosis (DIE), which can lead to a structural distortion of normal surgical plans. The most commonly affected sites are the ureter and the bladder. Early identification of such injuries is essential to minimize the impact of the damage on the patient; in fact, their identification in the intraoperative phase could not even determine outcomes both from a psychological and an organic-functional point of view for the patient. We will then discuss some anatomical considerations for their prevention, the diagnostic techniques for identification and characterization, as well as the reconstructive surgical techniques and the principles of repair.

Keywords: iatrogenic injury; repair, ureter; bladder; endometriosis.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Treatment of complication after colo-rectal surgery for endometriosis

Treatment of complication after colo-rectal surgery for endometriosis

Roberto RossiniOrcid, Elisa BertocchiOrcid, Giacomo RuffoOrcid

1 – U.O.C. General Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona

Corresponding Author: Roberto Rossini

roberto.rossini@sacrocuore.it


DOI: 10.53146/lriog1202136

Abstract

Background: endometriosis is a chronic benign disease, characterized by the presence of endometrial glands and stroma outside the uterine cavity. It can frequently affect the intestinal tract, the rectum and the sigmoid colon are often interested. Surgery is a valid option in case of infertility, chronic pelvic pain, intestinal obstruction and worsening of quality of life. Postoperative outcome is often favourable. Most frequent complication are colorectal and recto-vaginal fistulas. Aim of our study is to review our datas and present our experience in the treatment of colo-rectal complication after surgery for endometriosis
Methods: we retrospectively included 3054 cases of colorectal surgery for intestinal endometriosis performed from 2001 to 2020 in our institution. On the basis of the postoperative outcome we included 543 complications for the segmental resection and 50 for the disc resection.
Results: major colo-rectal complications such as anastomotic leackage and recto-vaginal fistula were 218 (8.3%) and 43 (1,6 %) respectively. Other intestinal complications were: 23 (0.9%) bowel occlusions, 15 (0.3%) intestinal perforations and 132 (5.0%) anastomotic strictures. We also had 76 (2.9%) haemoperitoneum and 36 (1.4%) urinary tract injuries. The group of disc resection only had 47 (11.3%) intraluminal bowel bleeding and 3 (0.7%) perforations.
Conclusion: when conservative treatment fails surgery represents a safe and feasible approach for bowel deep infiltrating endometriosis, resulting in an improvement of pain, fertility and quality of life. The rate of complications after bowel resection appear to be acceptable and often reversible. To achieve this goal surgeons, gynecologist, urologist and all other professionals of the multidisciplinary team from high volume centers need to work together.

Keywords: endometriosis; colorectal resection; complications; anastomotic leackage; recto-vaginal fistula.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Ultrasound diagnostic criteria for ovarian and deep endometriosis

Ultrasound diagnostic criteria for ovarian and deep endometriosis

Mara AlbaneseOrcid, Carlotta Zorzi1, Anna Katarzyna StepniewskaOrcid, Paola De MitriOrcid, Giamberto Trivella1, Silvia Baggio1Orcid, Mariangela Fornalè, Marcello Ceccaroni1– Orcid

1 – Department of Obstetrics and Gynecology, Gynecological Oncology and Mini-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS “Sacro Cuore – Don Calabria” Hospital, Negrar di Valpolicella, Verona

Corresponding authors: Mara Albanese, Carlotta Zorzi

mara.albanese@sacrocuore.it, carlotta.zorzi@sacrocuore.it


DOI: 10.53146/lriog1202129

Abstract

Transvaginal ultrasonography is considered the first-line imaging technique for the diagnosis of endometriosis because it allows accurate exploration of the pelvis. In the evaluation of ovarian disease, ultrasonography is useful in recognizing endometrioma and distinguishing it from other diseases. The “typical” endometrioma is a unilocular cyst with “ground glass” echogenicity. The ultrasound features of endometriotic cysts change during pregnancy due to decidualization and with advancing age. In particular, the presence of vascularized solid component should raise suspicion of malignant formation. In the evaluation of extra-ovarian disease, ultrasound is useful to identify and evaluate the extention of DIE in the pelvic structures. The transvaginal evaluation is a dynamic and interactive exam. It is essential to identify the “sliding sign” of the anterior and posterior compartments, the tenderness of the tissues and organs, the“pain mapping” that means pain induced by the probe. Transvaginal ultrasonography allows for an accurate evaluation of the vagina, particularly the areas of the posterior and lateral vaginal fornixes, the retrocervical area, the uterosacral ligaments, and the rectovaginal septum. The slightly filled bladder allows to evaluate the bladder walls and the presence of endometriotic nodules that appear as linear or spherical hypoechoic lesions protruding towards the lumen, affecting the serosa, the muscle or the (sub) mucosa of the bladder. Deep rectal nodules appear as hypoechoic lesions with regular or irregular borders, poorly or non-vascularized on Color Doppler, which infiltrate the intestinal wall distorting its normal structure. An adequate ultrasound diagnosis is essential to perform adequate patient management.

Keywords: pelvic ultrasound; endometrioma; deep endometriosis; ovarian cyst.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Diaphragmatic endometriosis: diagnosis and laparoscopic treatment

Diaphragmatic endometriosis: diagnosis and laparoscopic treatment

Giovanni RoviglioneOrcid, Roberto Clarizia1, Daniele MautoneOrcid, Francesco Bruni1, Matteo Ceccerello1,  Alberto Claudio TerziOrcid, Marcello Ceccaroni1 – Orcid

1 -Department of Obstetrics and Gynecology, Gynecological Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS “Sacro Cuore – Don Calabria” Hospital, Negrar di Valpolicella, Verona

2 – Thoracic Surgery Division, IRCCS “Sacro Cuore – Don Calabria” Hospital, Negrar di Valpolicella, Verona

Corresponding Author: Giovanni Roviglione

giovanni.roviglione@sacrocuore.it


DOI: 10.53146/lriog1202135

Abstract

Diaphragmatic endometriosis (DE) is a rare and often misdiagnosed condition. Most of the times it is asymptomatic and due to the low accuracy of diagnostic tests, it is almost always detected during surgery for pelvic endometriosis. Its management is challenging and, until now, there are not guide-lines about its treatment. In fact, Literature reports a plenty of single-center small series or case-reports about case treated for DE, thus, still nowadays a general consensus for diagnosis or treatment of DE does not exist. However, Our Institution has collected the largest case-series of patient treated for DE, reporting high-effective surgical results and proposing laparoscopy as its ideal tool, for its high cost-benefits relationship and its low morbidity.
A proposal of algorithm for diagnosis and treatment of DE has recently been published by Our Institution with the aim to standardize the surgical appro- ach according to the type of lesion, and finally reducing the rate of under- or over-treatments and intra or post-operative complications.
Conclusions: this kind of surgery should be performed in a Referral Center by a gynecologic surgeon with onco-gynecologic expertise and skills, with the eventual support of a laparoscopic general surgeon, a specialized thoracic surgeon and a trained anesthesiologist.

Keywords: diaphragmatic endometriosis; thoracic endometriosis; extrapelvic endometriosis; laparoscopy; radical surgery.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Epidemiology and social impact of endometriosis today

Epidemiology and social impact of endometriosis today

Silvia BaggioOrcid, Giulia Mantovani1, Paola De MitriOrcid, Matteo CeccarelloOrcid, Maria Manzone1, Marcello Ceccaroni1– Orcid

1 – Department of Obstetrics and Gynecology, Gynecological Oncology and Mini-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS “Sacro Cuore – Don Calabria” Hospital, Negrar di Valpolicella, Verona

Corresponding author: Silvia Baggio

silvia.baggio@sacrocuore.it


DOI: 10.53146/lriog1202128

Abstract

Endometriosis is a chronic, persistent, recurrent pelvic disease that can cause debilitating symptoms and infertility or be completely asymptomatic. It is a very common disease among women of childbearing age, with a prevalence of around 2% in the low-risk population, from more than 40% in women with chronic pelvic pain and up to 50-60% in infertile women. It is believed that 176 million are the women affected worldwide, but the true prevalence rates are not fully known yet, mainly because the symptoms are often underestimated by primary care doctors and gynecologists, causing an average diagnostic delay of about 4-6 years. This delay is often the cause of an irrecoverable impairment of the quality of life of women, both physically, psychically and socially /relationally, as well as of an important loss of productivity and health costs soaring, making Endometriosis deserve the title of “social disease”. Understanding Endometriosis and its prevalence and improving the knowledge of its risk factors could help physicians to promptly recognize it or at least suspect it, and therefore direct the affected women to Specific Referral Centers, thus allowing an early taking charge with subsequent benefit for the single and for the society.

Keywords: endometriosis; epidemiology; burden; quality of life; costs; diagnostic delay.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Laparoscopic diagnosis and treatment of intestinal endometriosis

Laparoscopic diagnosis and treatment of intestinal endometriosis

Roberto Clarizia1, Giovanni RoviglioneOrcid, Francesco Bruni1, Daniele MautoneOrcid, Carlo Tricolore1, Matteo Ceccerello1, Paola De MitriOrcid, Giacomo RuffoOrcid, Marcello Ceccaroni1 – Orcid

1 – Department of Obstetrics and Gynecology, Gynecological Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS “Sacro Cuore – Don Calabria” Hospital, Negrar di Valpolicella, Verona

2 – Department of General Surgery, IRCCS “Sacro Cuore – Don Calabria” Hospital, Negrar di Valpolicella, Verona

Corresponding Author: Roberto Clarizia

roberto.clarizia@sacrocuore.it


DOI: 10.53146/lriog1202134

Abstract

The diagnosis and treatment of intestinal infiltrating endometriosis represents one of the most difficult challenges for an Endometriosis Unit, where such patients should be mandatorily referred. It is a condition that can be both asymptomatic and debilitating the quality of life of affected women, and which intersects with crucial issues such as reproductive desire and pelvic visceral functions. Correct treatment can indeed lead to a significant improvement in the quality of life but is not without long-term risk in terms of rectal, bladder and sexual dysfunctions, as well as peri-operative surgical complications.
The techniques of shaving, discoid resection and segmental resection should not be considered alternatives but distinct and each finds specific indications for specific subsets of patients taking into account on the size of the lesion, the depth of infiltration and patients symptoms.

Keywords: endometriosis; bowel resection; laparoscopy; bowel shaving; discoid resection.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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